View Full Version : Do you feel some doulas/midwives/advocates are TOO anti-intervention?

07-29-2010, 02:22 PM
I am 100% on board with the fact that ob/gyn/medicine has lead to way too much unnecessary intervention and too high a rate of c-section. And I very much support and appreciate the work of doulas, midwives, the birthing community, etc to change that.

BUT when I was interviewing doulas it bothered me that more than half of them assumed I had had an unnecessary c-section foisted on me and spent alot of our phone call trying to figure out where my OB had needlessly pushed intervention (and my OB had not!). And that a few seemed like they opposed intervention globally and on principle. In my case the odds were significant that either I or my baby or both of us would have died if we lived in an era where safe c-section was not available as we had multiple, serious complications.

It got on my nerves in part as a matter of pride - - I felt like I was being made out as this uninformed medical victim lead to the c-section slaughter. And it made me nervous that the doula or provider was SO gung-ho for natural vaginal birth that they would make me feel bad about or oppose a necessary intervention for DC2. DH in particular was worried sick about this latter issue because there in fact are some risk factors involved in this second birth.

Anyway, we ended up hiring a doula who is very experienced and extremely well-versed in terms of when to avoid intervention and when to pursue it. So, it all ended well.

But, the experience made me wonder: are we losing sight of the happy medium of USING technology/medicine when it can help us . . . but not being used by it.


07-29-2010, 04:24 PM
I agree. I think there is a trend toward the other extreme- not even just among midwives & doulas, because some of them are not even extreme enough for some of the natural birth women. There was the woman who gave birth to twins at home, unassisted- because no one wanted to take her as a patient. Hellooo? If not a single homebirth midwife wants you, maybe there is a take home message there. There was another woman who was ranting on some site I was on, that the midwives on the Farm (Ina May Gaskin's place) were too interventionist. This goes beyond the pale of normalcy IMHO. I am all for natural birth & I know how to do everything right. I chose my health care provider & I have to trust him.

As for some of those doulas you mentioned, some of them need to get a life. They are NOT health care providers & some of them need to remember their place. They are there to support. The OB or Midwife are in charge of the care. The CNMs mostly aren't like that. They are mostly accused of being too much like OBs. The ones you need to watch are the CPMs- who only do homebirths. They are not recognized in the hospitals. The happy medium should be that interventions have their place, but should not be used in every case.

07-29-2010, 04:25 PM
Oh, sure, and especially in some parts of the country - in San Francisco, where home births are the norm, just choosing to give birth in a hospital is seen as an unnecessary intervention! I was definitely turned off some doulas because they seemed new agey without the substance I was looking for.

The doula I went with is somewhat "woo" but self-admittedly so, and she has a wealth of experience as a midwife and doula, which came through loud and clear in our meetings and ultimately in the way she assisted me during labor, birth and post-partum. So I dealt with the woo, but also made my comfort level clear to her. At one point she was advocating for a homebirth VBAC and my DH and I made it clear that we were not comfortable with that, we wanted to have the baby in the hospital, and also that I was OK agreeing to the hep lock (which she was suggesting I didn't need) because I was GBS positive and a VBAC. But I didn't want an epidural under almost any circumstances, and she provided the support I needed (and helped DH do so) to make sure I didn't have to get one.

With all that, she was marvelous at the hospital in working with the L&D nurse and midwife as a team, advocating for me against unnecessary interventions (such as when the anesthesiologist came by pushing the epidural), but also agreeing to and even recommending some interventions that ended up helping me - such as IV fluids when I was dehydrated (the hep lock came in handy!), and a catheter when I was 10 cm dilated, desperately needed to pee but couldn't, and my contraction started slowing down. She respected the midwife's decisions on most things, but a couple of times, she pushed back in exactly the way I wanted her to.

I attribute this to good communication ahead of time what I was and wasn't comfortable with. I would recommend you do the same - even if it might seem to you that your doula will think "less" of you for making certain "concessions." Don't let that hold you back in the least. This is your journey, your body, and she is there to support you. A good doula will work with that, and it sounds like you have found such a person!

07-29-2010, 04:30 PM
I think there's a happy medium here that advocates and "true believers" on both sides tend to forget.

FWIW, I was with a midwife practice (ETA: at a major university hospital, rated in the top 10 nationally) for pg#1, and we both damn near died because the midwife who was attending my labor refused to believe (even at 36 hours of unproductive labor and a baby who wasn't moving at all!) we needed a c. Even I, in my extreme pain, could see our vitals were slipping waaaayyyy down, but when I said so, she snapped "no way do you need a c". An hour or so later we were flying down the corridor and people were screaming all around me.

And the epidural? Well, let's just say it didn't take.

Great. So I spent 3 days in ICU and my DS1 was born with an apgar of 1 and spent a week in NICU b/c we didn't go c soon enough.

Just my experience. But I think - obviously - c-sections are absolutely appropriate sometimes. Maybe there needs to be a better test for when that everyone can agree on; though I have to say with all the variables I don't know how reductionist logic will help us.

07-29-2010, 04:37 PM
I think it is difficult because our current birth climate and hospital culture doesn't provide much of a middle ground. So you end up with people polarized on both sides.

07-29-2010, 04:37 PM
There actually are better tests. If you are on the monitor & your doctor or midwife starts getting nervous about the heart rate- they can do scalp stimulation, scalp pH or fetal pulse ox. Any of those are accurate at telling you whether the baby is in distress.

Also, as with most things there is a huge range. There are doctors who are way to interventionist & midwives who are too into the midwifery care from the Dark Ages. There are also midwives who are epidural happy & doctors (like mine) who are willing to go for a vaginal breech. And there is everything in between.

07-29-2010, 04:39 PM
ITA. I hated hated HATED our birthing class with DD#1. They were anti everything. Seriously. If you weren't doing a water birth (the class was supposedly for hospital birth) out in the bush by candlelight, you were harming your child. It was so irritating.

My doula, bless her, was very "crunchy" and I know she had a hard time holding her tongue about my two c/s, but she did much better than some other people. I had people say the strangest things.

Without my emergency c/s with DD#1, she would not have made it and I might not have either. It was not a good situation at all, and the OB (on call, not my regular peri) did try other interventions first. I had a CNM head nurse with me for most of my labor and a 'regular' CNM for the rest. I still ended up with a c/s -- and TG for that.

With DD#2, all sorts of people had opinions about my scheduled c/s. I made it very crystal clear to anyone who looked sideways at me that it was scheduled by MY choice based upon medical advice from my perinatologist and OB. And everyone else could just shove it.

Opinions are like bellybuttons and all that....

07-29-2010, 04:55 PM
When selecting our doula, this was very important to me. I had been told that I would need a C-section b/c of some uterine scarring in my cornual myometrial wall. Because it was the contracting part of the uterus, I was told by a panel of doctors who convened on my behalf at the NIH in Wash that a c-section was the safest way to avoid uterine rupture. Flash forward to my 21wk u/s (level-2), and an MFM says that the scar tissue has miraculously disappeared, and that b/c I never had surgery to cut out the mass, the body likely absorbed the tissue and left the musculature in tact. Ergo, I would fully be allowed to attempt a vaginal delivery, in fact, *should* do a vaginal delivery--MFM's words. Either way, b/c that panel put the fear of God in me about rupturing and dying (along w/ the baby possibly dying too), it's hard for me to let go of the fear that we could end up in that type of situation (emergent C-section), and I wanted any doula I hired to be prepared for my special situation...and to not think I was a normal, healthy woman "whose body was made to do this." I wanted my doula to know that if my OBs are saying that I'm hemhorraging, to not even blink, just let it happen. After all, it's only a guess that I'm fine to deliver vaginally--they have no idea what kind of damage that cornual ectopic pg did to my uterus. Anyways, I'm so glad to have hired the doula we did! She's awesome. She loved the miracle of our story; she loved that doctors (esp MFMs, who can be so interventionist) are adamant that I attempt vag delivery barring other complications, and she loves that I want to attempt a natural, drug-free delivery to reclaim "the years the locusts have eaten" with our history of infertility, loss and medical surgeries. Anyways, I feel so blessed to have found our doula--esp one who's not judgmental, has an open mind, and has attended enough births to know when to step back and when to advocate.

07-29-2010, 05:05 PM
"But, the experience made me wonder: are we losing sight of the happy medium of USING technology/medicine when it can help us . . . but not being used by it."

The people that tend to sit on the more extreme ends of the spectrum turn me off, and I mean both sides. I do think there is a trend away from the happy medium and trusting healthcare providers, and fear it could cause more harm than good in the long run. I want the people providing medical care and advice to my family to be passionate and informed about what they're doing, but not to the point where it could compromise our health or safety. Interventions can be miraculous or devastating - I cringe when I hear people paint them as solely one or the other.

My midwife and doula make their personal preferences known if asked, but so far I have really appreciated that neither of them has pushed her beliefs on DH and I. (Haven't been through labor/delivery with the doula yet, but have met with her several times and so far she's just as supportive of what WE want as the midwife.) On a number of occasions, they have both put the ball back in my/our court when questions came up and encouraged us to do our own research and form our own opinions. Both of them include advocating for me/us in their job descriptions.

07-29-2010, 05:13 PM
I think the medium can be tough to find.

I had a homebirth with #3. Would have been fine w/ transfer to hospital, etc. if needed, and worked with a CNM for a homebirth (in that state, CNMs rarely do HB because they often can't get OB backup. Most HB midwives are CPMs whom are not legally able to be licensed in that state). My HB midwife did a mix of HB and hospital birth in her original homestate, and then was doing hospital births exclusively. Then right as we were in our last weeks, she opened a homebirth practice again. I felt confident that she wouldn't hesitate to have me transfer if needed. I was also 30 mins away from a hospital, which was in my comfort zone...provided she was willing to transfer quickly if things got funky. The CNM and I were in very clear agreement and I know she would have not hesitated to recommend transfer if she thought it was needed. (and she had 10+ years of hospital and homebirth experience).

I'm very anti unnecessary intervention, but am fine with intervention for myself if needed. No doubt. I think it comes down to really trusting your provider and finding someone on the same page.

07-29-2010, 05:21 PM
I'm sure there are the extremes out there, but it hasn't been my experience with the midwives I've dealt with. My OB practice is a couple of doctors and a whole bunch of midwives. My delivery was at the hospital. I had a bad experience with one of the doctors who tried to get me to do a c-section when it really wasn't necessary, and the attending midwife stood up for me. I was really appreciative. The doctor basically said, the heartbeat is going down (I had just had an epidural, so this was normal) and she had to leave in 15 minutes so I should have an emergency c section. At which point, the horrified midwife said "dr. I don't think she needs a c-section" and when the doctor walked out of the room a moment later said to me "you don't need a c-section. Wait 15 minutes until the next doctor comes on board." and she was right. the second doctor never even mentioned a C.

But my same midwife took one look at a friend of mine, who had had a C with her previous child, and told her she had to have another C. My poor friend was having such a huge baby. He ended up being over 10 lbs and she really wouldn't have been able to do VBAC. The midwife recognized this and never pushed her to try.

07-29-2010, 05:24 PM
Then there was the freakazoid lady who had a homebirth & lost the baby. She commented on the unnecesearean FB page that she would do it all over again because she 'got' her birth experience. Uh, hello? Thought pregnancy and birth were about both the mother AND the baby. Stop being so selfish.

07-29-2010, 05:25 PM
Swissair, yes, I def. have experienced this among other moms and moms-to-be too. None of them meant any harm but at least a few times I felt like I was justifying my c-section - - and my OB has a 5% c-section rate. And I can't believe someone said the Farm is too interventionist!

Mommylamb, I do totally agree that many obs and medical-model midwives DO push unnecessary C-sections. When you look at the c-section rate, particularly in major academic centers that is irrefutable. But, I guess I see danger in going to the other extreme as well. Especially because it seems to me that virtually all doulas and the majority of natural childbirth/alternative/solo practice midwives don't see their mom patients die on the table. While that can make you too risk-adverse (and apparently has) I think there is also some value to realizing that this is the real deal, someone could die from my decisions. When you are a doula you haven't had this experience and even most midwives are not the caregiver when things go seriously south as at that point its a transfer to hospital/md.

I also thought about this because in reading some natural childbirth books to prepare there was in some cases serious romanticization of slaves giving birth in the fields, poor people laboring on dirt hut floors, etc. and some hinting that we would all be better off if we could go back in time. Well, ALOT of women died in childbirth historically. Most women in developed countries today would love to have at least as a back-up to home birth the resources of hospital, anesthesia, surgery, and NICU. Sometimes the attitude in the U.S. among certain "diehards" is a little off-putting and it seems to me on occasion that certain people who have lead very middle class, relatively charmed lives sometimes don't really grasp the idea that something very bad, such as a child-birth related death or major disability, *could* happen to them if they decide to actively pursue high risk and birth their high risk twins at home without assistance!!

With respect to communication, I think everyone is right that that is key. I did bring up our feelings with respect to risk-benefit balancing with doulas and others but I think in more clinical terms.

I finally realized that the statement that made the most sense to the most doulas/natural childbirth oriented people was: "I don't want to set myself up for feeling like a failure at my own birth (with respect to intervention or opting for pain medication later in labor). And I would be really crushed during labor and delivery if I got the sense from you that you felt like I had failed. No one's birth should feel like a failure, no matter what happens or doesn't happen medically."

It took me a while though to come up with this irrefutable yet doula/sensitive/crunchy framing of the issue!

07-29-2010, 05:28 PM
No one should have to justify their birth to anyone. I've stopped sharing it with people. I just mention that everything TG went smoothly & I had a beautiful, healthy baby at the end. I can't get over the fact that I take no medication, have autonomy over my labor & delivery, but I am too interventionist because I used a hospital & an OB. Sorry, actually, my husband's feelings matter more than yours. So sorry.

(and anyone who thinks the Farm is interventionist doesn't get a second thought from me. That is way too crazy. If Ina May or one of her midwives think someone needs a hospital transfer or a c-section, then they do. Period.)

07-29-2010, 08:01 PM
This is a little OT, but this thread reminded me of it and I hope it's not highjacking. This book talks about the history of childbearing practices and interventions: Get me out: A History of Child Birth from the Garden of Eden to the Sperm Bank. It's amazing to see what helped and hurt as far as medicine and technology go down through the ages, and what trends were popular, and why. The author (Randi Epstein) is pretty good about keeping her opinion out of the work, and keeps it interesting and informative rather than textbook-dry: